The main problems with this news release promoting an abstract from a radiology meeting are that it fails to mention the research is unpublished, and there are significant limitations which may well preclude a headline such as: “Pulsed Radiofrequency (pRF) Relieves Acute Back Pain and Sciatica.”
The touted benefits of pRF (pulsed energy applied to nerve roots of the spine by a probe) noted in this study are based on difficult-to-reproduce patient questionnaires, and framed with language that makes it very difficult for readers to place in an understandable context.
Although alternatives are nicely covered — benefits, costs, availability, and potential harms of the outpatient probe procedure are not.
We also reviewed a HealthDay news story about the study. Both the story and news release would have been improved with more discussion about cost, benefits and harms.
Chronic back pain that does not respond to conservative treatment, and sometimes includes shooting pain into the buttocks and leg (sciatica), is difficult to treat, a leading cause of disability, and poses a huge economic burden to both individuals and the health care system.
Although the search for treatments that are “minimally invasive” are well-intentioned and much needed, this catchphrase can be quite misleading. As we’ve written before, many readers erroneously equate “minimally invasive” with more advanced and effective, and involving fewer complications and recovery time. Rather than prey on this notion, releases should clarify if procedures touted in this way even come close to meeting such expectations.
Many back patients have very straightforward questions they need answered: Do I need surgery? If not, what are my alternatives? How effective are those alternatives? What are the benefits vs. risks involved? What will it cost me? Not answering those questions clearly (or making it clear if the answers are unknown) does readers a disservice.
Back pain creates tremendous personal, family and economic burdens. In the majority of individuals, the source of the pain cannot be identified, and undoubtedly there are many different causes of back pain. If the source of pain in any individual can be identified accurately, specific interventions may be able to be developed to treat that subset of patients resulting in improved quality of life for those individuals and less economic burden. But it’s also important to keep in mind that in the vast majority of individuals, the pain resolves spontaneously without any residual disability.
Costs are not included.
Comparing the cost of the three treatment options mentioned in the release — CT-guided pRF, CT-guided steroid injections, and lumbar disk surgery — would have been appropriate and helpful.
An assumption is made that the cost of this procedure is less than a surgical intervention. This is often not the case, and “minimally” invasive approaches can cost more.
The news release reports these 1-year outcomes:
The terminology here is very vague. It would have been helpful to clarify what the rate and probability of “perceived recovery” mean, and how they’re measured.
The release leads with a phrase we find problematic: “minimally invasive.” For many readers this connotes a quick, “safe and effective” intervention as mentioned in the release. But “minimally invasive” can potentially have more complications than a prior “more invasive” approach.
No instrumentation close to the spine or its nerve roots is risk-free. Nerve damage and infection are two potential complications that should have been mentioned.
This is a major weakness of the news release because the following key points are omitted:
No disease mongering.
Chronic lower back pain is not only very common and very difficult to treat, but it’s also one of the leading causes of disability and missed work days.
Study funding is not included.
A review of the meeting abstract reveals no conflicts of interest disclosed by the seven authors.
The news release defines what alternatives are available for acute back pain with sciatica, including pain medications, cortisteroids and surgery. It details outcomes in patients treated with steroid injections compared with pRF.
It’s not made clear for readers if this is an experimental therapy, or if it is widely available.
The procedure is, in fact, a refined technique of an older procedure.
The release doesn’t explain what’s novel about the research.
The rPF procedure has been used extensively for a variety of chronic pain conditions for years.
The headline is misleading. The source of back pain is usually unknown and even if an imaging study demonstrates a disc herniation it is usually not the identifiable cause of the pain. The title could lead people to seek treatment for their imaging finding but not resolve their pain.
It’s unjustified to make broad claims as found in the headline based on unpublished data.